Internists more likely to be sued for high-severity injuries than doctors in other specialties, according a study of 1,180 claims against internal medicine physicians insured by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, based in Napa, CA.
The most common malpractice claims in internal medicine are diagnosis related, with both hospitals and physician practices at risk. Based on claims that closed from 2007 to 2014, the analysis found that 39% of all claims alleged failed, delayed, or wrong diagnosis, with 56% alleging inadequate patient assessments such as failure or delay in ordering diagnostic tests.
High-severity injuries accounted for 58% of claims against internal medicine specialists, much higher than the 34% of claims against all physicians. More than a third of all injuries prompting malpractice claims in internal medicine took place in hospitals.
The study involved practicing physicians who reviewed the cases to determine the top factors that contributed to patient injury. The top three factors were patient assessment issues (33%), patient factors such as noncompliance with the treatment plan (25%), and communication breakdown between patient or family and the provider (21%). In many cases, more than one factor often contributed to the injury. (The study results are available online at: http://bit.ly/2cXLHIH.)
“This study reinforces that physicians fail to diagnose and treat accurately for a variety of reasons,” said Howard R. Marcus, MD, internal medicine physician with Austin (TX) Regional Clinic in a statement released with the study results. “The average primary care physician will diagnose about 400 different diseases a year and occasionally encounters a rare medical condition that he or she may have never seen before. It is in this context that failure to diagnose may be caused by an error or lapse in reasoning rather than a failure of knowledge or clinical skill. The case studies in this study will be used in our medical group’s continuing medical education to demonstrate to our more than 250 primary care physicians how to avoid pitfalls in medical decision-making.”
The Doctors Company offered advice on how to avoid the most common malpractice complaints in internal medicine. “Physicians and office staff should take the time to explore patient complaints, especially when the patient makes similar complaints on return visits,” according to the report. “Diagnosis and treatment depend on skilled patient assessments. Patient complaints are the first opportunity to gather information. The ability to engage the patient in order to obtain an accurate history is especially important when developing a differential diagnosis.”
The report also recommends thoroughly evaluating all age groups of patients with atypical chest pain, noting that 22% of the patients in this study who had myocardial infarction or cardiac were in their 40s and presented with atypical chest pain.
Healthcare providers also should pay close attention to calls and concerns from postoperative patients, the report says, especially since community-acquired and nosocomial infections can be difficult to diagnose.
“Diagnosing postoperative infections and other complications might be even more challenging. Internists are often called upon to provide postoperative care at a time when patients are unable to determine whether symptoms are a normal part of recovery or are complications that need medical assistance,” the report says. “Clearly document the clinical history and physical examination. Document the details of telephone advice, and include any follow-up and appointment information.”
